Dystonia in childhood is defined as ''a movement disorder in which involuntary sustained or intermittent muscle contractions cause twisting and repetitive movements, abnormal postures, or both. ''. In contrast to spasticity, dystonia is inherently more difficult to observe and measure, particularly when spasticity co-exists. When classified according to the dominant form of tone abnormality, it accounts for up to 2-15% of cases. However it is often overlooked in the diagnostic formulation of motor aspects of cerebral palsy, and therefore does not necessarily figure in treatment decision-making. Under-recognised dystonia, when co-existent with spasticity, can produce unpredictable surgical outcomes in the management of gait disorders and associated musculoskeletal deformities. In addition, other abnormal movements such as chorea and athetosis may be observed in these children, adding to the complexity of the movement disorder, but are rarely classified as dominant abnormalities. Improving the recognition of dyskinesias, and situations where they co-exist with spasticity, is important not only for promoting a clearer description of tone and movement abnormalities, but also to help tailor appropriate treatments leading to improved outcomes.